住院精神分裂症患者整合治疗模式的建立与疗效评估
发布时间：2018-07-17 06:16
【摘要】：研究背景:精神分裂症是一组病因未明的重性精神疾病,具有高发病率和高致残率的特点,为自身,家庭及社会带来沉重负担。虽然药物治疗一直是精神分裂症治疗的基石,却有其局限性。研究表明,大部分精神分裂症患者需要长期服药治疗,同时也要面对各种药物副作用,依从性差,复发风险高,社会功能难改善等问题。而联合使用心理治疗、家庭教育及认知行为疗法等社会心理学干预手段,对于增加精神分裂症患者的服药依从性、提高生活质量、改善社会功能方面具有较大帮助,这弥补了单纯药物治疗的不足。然而,社会心理学干预治疗目前仅在我国大城市的精神专科有所开展,且多针对门诊或慢性患者,因时间、空间所限,传统的长疗程社会心理学干预治疗难以在我国精神分裂症患者中普及,这限制了我国精神分裂症患者长期治疗的有效性。研究目的:本研究尝试利用药物治疗结合认知行为治疗和康复治疗技术及临床个案管理,建立一套新的“强化-巩固”整合治疗模式,并从精神症状,治疗依从性,复发率,和社会功能四个方面评估该治疗模式的有效性,为探讨适用于我国精神分裂症住院患者的治疗新模式提供思路及实证基础。研究方法:研究对象为2012年至2015年,在广州医科大学附属脑科医院的精神科住院的170名精神分裂症患者,并随机分配为整合治疗组(86名)和单纯药物治疗组(84名)。对这些患者进行一般人口学资料收集,阳性阴性症状量表(Positive and negative syndrome scale,PANSS)、临床疗效总评量表(Clinical Global Impression Scale,CGI-S)及个人与社会功能量表(Personal and social perforance scale,PSP)评定,并以此作为基线数据。单纯药物治疗组患者仅使用抗精神病药物治疗,整合治疗组患者除使用抗精神病药物外,还给予认知行为治疗和康复治疗及全程临床个案管理。认知行为疗法全程共有20次治疗。认知行为治疗分为强化治疗阶段和巩固治疗阶段。强化治疗阶段按照每周1-2次的频率,在12周内共实施17次治疗,每次时间约45分钟。巩固治疗阶段则在入组后第6个月、第9个月和第12个月,分别进行一次治疗,每次时间约45分钟。康复治疗全程共15次治疗,包括三个方面的内容:用药管理、症状管理和社会技能训。康复治疗亦分为强化治疗阶段和巩固治疗阶段。强化治疗阶段按照每周1-2次的频率,共进行12治疗,每次时间约120分钟。巩固治疗阶段则在入组后在第3个月、第6个月和第9个月,分别予以1次治疗,每次时间约120分钟。对所有患者在入组后的第3个月、第6个月、第12个月,分别进行一次随访,并对其进行PANSS、CGI-S、PSP量表评定。治疗效果的评估包括精神症状,依从性,复发率,和社会功能四个方面。所有数据采用SPSS20.0软件进行统计分析。根据资料类型的不同采用了独立样本t检验、皮尔森卡方(χ2)检验和费舍尔精确检验来比较两组病人的基线特征。治疗后PANSS、CGI和PSP量得分的变化分析采用重复测量资料的混合效应模型分析(Mixed Effects Model for Repeated-Measures analyses,MMRM)。分析治疗因素、时间因素以及时间与治疗因素的交互效应时,通过对基线得分采用非限制性的协方差分析来检验。评估时间点分别为基线期,入组后第3、第6和第12个月。检验水准为α=0.05。研究结果:1.人口学资料统计:共118例(69.4%)患者完成12个月随访。整合治疗组随访12个月的完成率显著高于单纯药物治疗组(p0.05)。两组的年龄,性别,受教育程度,发病年龄及病程均无显著差异(P0.05)。2.PANSS、CGI-S、PSP评分:在基线期,整合治疗组患者的PANSS一般精神病理量表分,个人和社会关系得分均显著高于单纯药物治疗组(P0.05)。在入组后第12个月,两组患者的PANSS总分,CGI-S得分均较基线期显著下降(p0.001)、PSP总分均较基线期显著提高(p0.001)。在入组后第6个月,整合治疗组的PANSS总分、PANSS阳性量表分、PANSS一般精神病理量表分及CGI-S得分均显著低于单纯药物治疗组(p0.05)。在入组后第3个月,整合治疗组PSP量表的自我照料得分,和扰乱及攻击行为得分均显著低于单纯药物治疗组(p0.05)。3.复发率评估:整合治疗组随访12个月内复发率显著低于单纯药物治疗组(p0.05)。整合治疗组随访12个月内的再次住院率及平均住院次数均显著低于单纯药物治疗组(p0.05)。4.治疗依从性评估:两组随访12个月内总的药物不依从率为38.2%。整合治疗组的不依从率显著低于单纯药物治疗组(p0.001)。研究结论:1.精神分裂症的整合治疗模式与单纯药物治疗模式相比,能更好地改善患者的精神症状,提高依从性,降低临床复发率,和改善社会功能。2.精神分裂症的整合治疗模式与单纯药物治疗模式相比,能更早地改善患者的社会功能。
[Abstract]:Background: schizophrenia is a group of unidentified heavy mental diseases with a high incidence and high disability rate, which brings a heavy burden to itself, family and society. Although drug treatment has been the cornerstone of the treatment of schizophrenia, it has its limitations. The study shows that most schizophrenic patients need long-term medication treatment. At the same time, we should also face the problems of adverse drug side effects, poor compliance, high recurrence risk, and social function difficult to improve. And social psychological intervention, such as psychotherapy, family education and cognitive behavioral therapy, should be used to improve the quality of life and social function of patients with schizophrenia. It helps to make up for the deficiency of pure drug treatment. However, social psychological intervention therapy is currently only carried out in the psychiatric specialist of large cities in our country, and more targeted to outpatient or chronic patients. Due to time and space, the traditional long course of social psychological intervention is difficult to popularize in the schizophrenic patients in our country. The purpose of this study is to establish a new "strengthening consolidation" integrated treatment model with four aspects of mental symptoms, treatment compliance, recurrence rate and social function. The effectiveness of the treatment model was estimated to provide an idea and an empirical basis for exploring the new mode of treatment for schizophrenic inpatients in China. The study was conducted from 2012 to 2015 at the psychiatric department of the Guangzhou Medical University, affiliated to the Guangzhou Medical University, which was randomly assigned to an integrated treatment group (86 The general demographic data collection, the positive negative symptom checklist (Positive and negative syndrome scale, PANSS), the total clinical efficacy scale (Clinical Global Impression Scale, CGI-S), and the individual and social functional scale (Personal) were evaluated for these patients. They were used as baseline data. The patients in the simple drug treatment group were treated with antipsychotic drugs only. The patients in the integrated treatment group were given cognitive behavioral therapy and rehabilitation treatment as well as the whole course of clinical case management. Cognitive behavior therapy was divided into 20 treatments. Cognitive behavior therapy was divided into intensive treatment stage, and cognitive behavioral therapy. Strengthening the treatment stage. The intensive treatment stage, according to the frequency of 1-2 times a week, was performed 17 times within 12 weeks, each time of about 45 minutes. The consolidation treatment stage was sixth months, Ninth months and twelfth months after entering the group, with a time of about 45 minutes each time. The whole course of rehabilitation was treated in a total of 15 times, including three aspects. Medication management, symptom management and social skills training. Rehabilitation therapy is also divided into intensive treatment stage and consolidation treatment stage. The intensive treatment stage, according to the frequency of 1-2 times a week, is treated with 12 treatments, each time is about 120 minutes. The consolidation treatment stage is treated in third months, sixth months and ninth months after entering the group, and each time is treated with 1 times, each time. An interval of about 120 minutes. All patients were followed up for third months, sixth months and twelfth months after entering the group. The PANSS, CGI-S, and PSP scales were evaluated. The evaluation of the therapeutic effect included four aspects of mental symptoms, compliance, recurrence, and social function. All data were analyzed by SPSS20.0 software. Independent sample t test was used in different types. Pearson chi square (chi square) test and Fisher accurate test were used to compare the baseline characteristics of the two groups. The changes in the PANSS, CGI, and PSP scores after treatment were analyzed by the mixed effect model analysis (Mixed Effects Model for Repeated-Measures analyses, MMRM). Treatment factors, time factors and interaction effects of time and treatment factors were tested by non restrictive covariance analysis on baseline scores. The time points were evaluated at baseline, third, sixth, and twelfth months after entering the group. The test level was alpha =0.05. results: 1. oral data statistics: 118 cases (69.4%) completed 12 months. The completion rate of the integrated treatment group was significantly higher than that of the drug treatment group (P0.05). The age, sex, education, age and course of disease were not significantly different in the two groups (P0.05).2.PANSS, CGI-S, and PSP score: at the baseline, the general psychopathological score of the PANSS in the integrated treatment group, and the scores of personal and social relationships were all Twelfth months after entering the group, the total score of PANSS was significantly lower than the baseline (p0.001), and the total score of PSP was significantly higher than the baseline (p0.001) in the twelfth months after entering the group. The total PANSS score, the PANSS positive scale, and the PANSS general psychopathology scale and CGI-S in the integrated treatment group were sixth months after the entry of the group. The scores were significantly lower than that of the simple drug treatment group (P0.05). The self care score of the PSP scale in the integrated treatment group and the score of disturbance and attack behavior were significantly lower than that of the simple drug treatment group (P0.05).3. recurrence rate in the third months after the entry group: the recurrence rate in the integrated treatment group was significantly lower than that of the simple drug treatment group (P0.05). The rate of rehospitalization and average hospitalization in the treatment group were significantly lower than that in the treatment group (P0.05).4. treatment compliance assessment within 12 months of follow-up. The total drug failure rate in the two group was significantly lower than that of the drug treatment group (p0.001) in the 38.2%. integration group within 12 months of follow-up. Compared with the simple drug treatment model, the combined treatment model can better improve the patient's mental symptoms, improve the compliance, reduce the rate of clinical recurrence, and improve the integrated treatment mode of social function.2. schizophrenia and the simple drug treatment model, and can improve the social function of the patients earlier.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.3
本文编号：2129361
[Abstract]:Background: schizophrenia is a group of unidentified heavy mental diseases with a high incidence and high disability rate, which brings a heavy burden to itself, family and society. Although drug treatment has been the cornerstone of the treatment of schizophrenia, it has its limitations. The study shows that most schizophrenic patients need long-term medication treatment. At the same time, we should also face the problems of adverse drug side effects, poor compliance, high recurrence risk, and social function difficult to improve. And social psychological intervention, such as psychotherapy, family education and cognitive behavioral therapy, should be used to improve the quality of life and social function of patients with schizophrenia. It helps to make up for the deficiency of pure drug treatment. However, social psychological intervention therapy is currently only carried out in the psychiatric specialist of large cities in our country, and more targeted to outpatient or chronic patients. Due to time and space, the traditional long course of social psychological intervention is difficult to popularize in the schizophrenic patients in our country. The purpose of this study is to establish a new "strengthening consolidation" integrated treatment model with four aspects of mental symptoms, treatment compliance, recurrence rate and social function. The effectiveness of the treatment model was estimated to provide an idea and an empirical basis for exploring the new mode of treatment for schizophrenic inpatients in China. The study was conducted from 2012 to 2015 at the psychiatric department of the Guangzhou Medical University, affiliated to the Guangzhou Medical University, which was randomly assigned to an integrated treatment group (86 The general demographic data collection, the positive negative symptom checklist (Positive and negative syndrome scale, PANSS), the total clinical efficacy scale (Clinical Global Impression Scale, CGI-S), and the individual and social functional scale (Personal) were evaluated for these patients. They were used as baseline data. The patients in the simple drug treatment group were treated with antipsychotic drugs only. The patients in the integrated treatment group were given cognitive behavioral therapy and rehabilitation treatment as well as the whole course of clinical case management. Cognitive behavior therapy was divided into 20 treatments. Cognitive behavior therapy was divided into intensive treatment stage, and cognitive behavioral therapy. Strengthening the treatment stage. The intensive treatment stage, according to the frequency of 1-2 times a week, was performed 17 times within 12 weeks, each time of about 45 minutes. The consolidation treatment stage was sixth months, Ninth months and twelfth months after entering the group, with a time of about 45 minutes each time. The whole course of rehabilitation was treated in a total of 15 times, including three aspects. Medication management, symptom management and social skills training. Rehabilitation therapy is also divided into intensive treatment stage and consolidation treatment stage. The intensive treatment stage, according to the frequency of 1-2 times a week, is treated with 12 treatments, each time is about 120 minutes. The consolidation treatment stage is treated in third months, sixth months and ninth months after entering the group, and each time is treated with 1 times, each time. An interval of about 120 minutes. All patients were followed up for third months, sixth months and twelfth months after entering the group. The PANSS, CGI-S, and PSP scales were evaluated. The evaluation of the therapeutic effect included four aspects of mental symptoms, compliance, recurrence, and social function. All data were analyzed by SPSS20.0 software. Independent sample t test was used in different types. Pearson chi square (chi square) test and Fisher accurate test were used to compare the baseline characteristics of the two groups. The changes in the PANSS, CGI, and PSP scores after treatment were analyzed by the mixed effect model analysis (Mixed Effects Model for Repeated-Measures analyses, MMRM). Treatment factors, time factors and interaction effects of time and treatment factors were tested by non restrictive covariance analysis on baseline scores. The time points were evaluated at baseline, third, sixth, and twelfth months after entering the group. The test level was alpha =0.05. results: 1. oral data statistics: 118 cases (69.4%) completed 12 months. The completion rate of the integrated treatment group was significantly higher than that of the drug treatment group (P0.05). The age, sex, education, age and course of disease were not significantly different in the two groups (P0.05).2.PANSS, CGI-S, and PSP score: at the baseline, the general psychopathological score of the PANSS in the integrated treatment group, and the scores of personal and social relationships were all Twelfth months after entering the group, the total score of PANSS was significantly lower than the baseline (p0.001), and the total score of PSP was significantly higher than the baseline (p0.001) in the twelfth months after entering the group. The total PANSS score, the PANSS positive scale, and the PANSS general psychopathology scale and CGI-S in the integrated treatment group were sixth months after the entry of the group. The scores were significantly lower than that of the simple drug treatment group (P0.05). The self care score of the PSP scale in the integrated treatment group and the score of disturbance and attack behavior were significantly lower than that of the simple drug treatment group (P0.05).3. recurrence rate in the third months after the entry group: the recurrence rate in the integrated treatment group was significantly lower than that of the simple drug treatment group (P0.05). The rate of rehospitalization and average hospitalization in the treatment group were significantly lower than that in the treatment group (P0.05).4. treatment compliance assessment within 12 months of follow-up. The total drug failure rate in the two group was significantly lower than that of the drug treatment group (p0.001) in the 38.2%. integration group within 12 months of follow-up. Compared with the simple drug treatment model, the combined treatment model can better improve the patient's mental symptoms, improve the compliance, reduce the rate of clinical recurrence, and improve the integrated treatment mode of social function.2. schizophrenia and the simple drug treatment model, and can improve the social function of the patients earlier.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.3
【参考文献】
中国期刊全文数据库 前10条
1 熊祖伦;;精神分裂症药物治疗进展[J];临床心身疾病杂志;2015年06期
2 郑银佳;麦家铭;周燕玲;肖蕴珊;龙建;何红波;;精神分裂症患者家庭负担影响因素的研究进展[J];四川精神卫生;2015年04期
3 孙国英;易正辉;张艳欣;曹艺宁;;家庭治疗对精神分裂症患者的疗效及家庭功能的影响[J];国际精神病学杂志;2015年02期
4 程进博;笈彤宇;王岩;张琳;齐欣;;利培酮联合认知行为治疗精神分裂症残留型症状的效果[J];广东医学;2015年05期
5 曹九英;朱建忠;许律琴;林连英;乔胜宇;吴少钗;;认知行为干预对首发精神分裂症康复效果的追踪调查研究[J];精神医学杂志;2014年04期
6 周燕玲;Rosenheck RA;Mohamed S;范妮;宁玉萍;何红波;;回顾性评估中国广州一家大型精神病医院再住院的相关因素(英文)[J];上海精神医学;2014年03期
7 许秀峰;;单一用药是精神分裂症药物治疗的主流[J];中华精神科杂志;2014年03期
8 梅其一;;精神分裂症的药物联合治疗[J];中华精神科杂志;2014年03期
9 陈华林;;社会技能训练对精神分裂症患者临床结局的研究[J];现代诊断与治疗;2014年10期
10 苏展;马迎军;叶小宁;吴延波;邓秋香;林中健;刘丙理;;社区精神分裂症患者居家生活技能训练对照研究[J];社区医学杂志;2014年10期
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